Cognitive Vulnerability to Depression in Seasonal Affective Disorder: Predicting Mood and Cognitive Symptoms in Individuals with Seasonal Vegetative Changes

Research indicates that seasonal fluctuations in vegetative functions (e.g., sleep, appetite, and energy) occur to varying degrees in the general population and a large fluctuation in vegetative functioning is often considered the core of seasonal affective disorder (SAD). The purpose of the present study was to determine if, among those with seasonal changes in vegetative functioning, a cognitive vulnerability to depression is associated with an increased risk for developing the cognitive and affective symptoms of SAD. Results indicate that participants with more dysfunctional attitudes, a more ruminative response style, and a more internal attributional style for negative events report experiencing more severe mood and cognitive symptoms of depression during the winter, controlling for the severity of vegetative symptoms. This was the case both for retrospective reports of typical symptoms and prospective reports of actual symptoms. These results provide support for Young’s dual vulnerability model, in which cognitive factors interact with environmentally mediated biological factors in the pathogenesis of full-symptom SAD, and suggest that cognitively-oriented interventions may be useful as adjunctive or alternative treatments for SAD.

Ruminative Response Style and the Severity of Seasonal Affective Disorder

Research generally has supported the hypothesis of the Response Style Theory that a ruminative response style is associated with a greater severity of depression episodes. However, no published research has applied this theory to seasonal affective disorder (SAD). We examined the relationship between response style and severity of winter symptoms in a longitudinal study of individuals previously diagnosed with SAD. Eighteen participants kept accounts of their mood and their responses to mood for 14 consecutive days in the fall. Statistical modeling of these data yielded measures of response style for each participant. Ruminative response style, but not distracting response style, predicted symptom severity in winter, controlling for severity in the fall. As suggested by the Dual Vulnerability Hypothesis of SAD, ruminative response style interacted with fall vegetative symptom severity to predict winter nonvegetative symptom severity. Results also suggest that distracting response style may consist of two different types of response.     

Automatic Thoughts and Psychological Symptoms: A Cross-Cultural Comparison of American and Spanish Students

This study examined the structure of automatic thoughts and relations between automatic thoughts and psychological symptoms from a cross-cultural perspective. Spanish university students (N = 437) and American university students (N = 349) completed the Automatic Thoughts Questionnaire-Revised (ATQ-R) and the Young Adult Self-Report. Results supported a hierarchical arrangement of cognitions in which four first-order categories of self-talk (Dissatisfaction, Negative Self-Concept, Inability to Cope, and Positive Thoughts) were encompassed by two broad factors of Positive and Negative Self-Talk. The pattern of associations between automatic thoughts and symptoms of anxiety, depression, and externalizing problems supported both the cognitive content-specificity theory and the tripartite model of anxiety and depression. Multiple group covariance structure analysis showed that the structure of the ATQ-R and relations between the ATQ-R and symptoms were comparable in both groups, suggesting that the nature of automatic thoughts is similar across Western cultures.     

Cognitive and Psychophysiological Correlates of Subsyndromal Seasonal Affective Disorder

This study longitudinally examined cognitive and psychophysiological factors in females who met criteria for subsyndromal seasonal affective disorder (S-SAD) and nondepressed, low seasonality controls. Participants (N = 46) were tested twice, during one winter month (i.e., December or January) and during one nonwinter month (i.e., September or April). At each assessment, participants completed measures of negative automatic thought frequency, mood, and seasonality as well as three experimental tasks (a psychophysiological task, a schematic faces task, and a modified Stroop task). Women with S-SAD and controls differed at both assessments on frequency of automatic negative thoughts and emotional and psychophysiological reactivity to light-relevant stimuli. These results highlight the need for research examining a possible cognitive vulnerability to symptom development and maintenance across the spectrum of seasonality.     

Cognitive Reactivity in Everyday Life as a Prospective Predictor of Depressive Symptoms

We used PDA devices and an experience sampling technique to assess participants’ negative mood and thoughts as they engaged in their normal daily routines over the course of a week. We then calculated each person’s own unique relationship between mood and thoughts, and used this index of cognitive reactivity to predict depressive symptoms at 6-month follow-up. Participants who demonstrated a stronger link between their momentary negative mood and negative cognitions reported more depressive symptoms at follow-up than those who had a weaker relationship between mood and cognitions. Further, this cognitive reactivity index was a better predictor of follow-up depressive symptom scores than initial depressive symptoms, dysfunctional attitudes, average experienced negative mood or thoughts, or variability of negative mood or thoughts. These results are consistent with earlier findings and build on previous research by demonstrating that naturally occurring cognitive reactivity is predictive of future mood disruptions.     

Mood Matters: Negative Mood Induction Activates Dysfunctional Attitudes in Women Vulnerable to Depression

Cognitive theory holds that dysfunctionalattitudes are important risk factors for depression.Critics have questioned this view, noting that, althoughdysfunctional attitudes are elevated in depression, they are not evident in vulnerable individualswho are asymptomatic. To deal with this criticism,Miranda and Persons (1988) have advanced the mood-statedependent hypothesis, which suggests that cognitive vulnerability factors are indeed present invulnerable individuals, but remain dormant untilactivated by negative mood. To test this hypothesis, 33women with and 67 women without histories of depression reported dysfunctional attitudes before andafter a film negative mood induction. As predicted,vulnerable subjects who reported increased negative moodreported increased dysfunctional attitudes.Unexpectedly, nonvulnerable subjects who reported increasednegative mood reported decreased dysfunctionalattitudes. These findings support the mood-statedependent hypothesis, and suggest that a deficit in theability to regulate negative emotions may be animportant feature of vulnerability todepression.     

A Daily Life Comparison of Sociotropy-Autonomy and Hopelessness Theories of Depression

The hopelessness theory and Beck’s cognitive theory of depression were compared, controlling for other factors associated with mood change and stress reactivity. Using a high-risk design, 179 individuals were selected based on cognitive vulnerabilities and substance use frequency. Assessments of mood, daily events, and specific attributions were acquired using the Experience Sampling Method. Strong support was found for attributional style and sociotropy as indirect determinants of depressed mood, as well as for the notions of causal mediation and vulnerability specificity. Hopelessness theory explained a slightly larger portion of variance in depressed mood overall. The personality diatheses described by either theory were largely independent of each other and their mechanisms of action were not influenced by depression history or substance use.     

Mechanisms of action of cognitive therapy: The relative contributions of technical and interpersonal interventions

The contributions of changes in cognitions (degree of belief in automatic thoughts) and the patient's relationship with his therapist to mood changes occurring during sessions of cognitive therapy were examined in data collected from 17 depressed and anxious patients. Results showed that both changes in automatic thoughts and the patient's relationship with his therapist made independent, additive contributions to mood changes. In addition, two patient characteristics (initial degree of belief in automatic thoughts and diagnosis) made significant unique contributions to mood changes. The stronger the patient's initial belief in his automatic thoughts, the smaller the mood change occurring in the session. Smaller mood changes also occurred in patients with a personality disorder diagnosis. These results suggest that mood changes in cognitive therapy sessions are a function of three types of factors: technical cognitive therapy interventions, the patient's relationship with his/her therapist, and patient characteristics. A multiple regression model with independent variables measuring these factors accounted for 89% of the variance in mood change in the session.We thank our patients for their generous contributions. Anna Rose Childress and Juli Kinchla contributed to the inception of the study. We thank Jeffrey M. Perloff for advice concerning the statistical analysis. Jonathan Baron, Susan Krantz, Ricardo Muõz, S. Lloyd Williams, and the anonymous reviewers gave helpful comments on an earlier draft. This paper was presented at a meeting of the Society for Psychotherapy Research, Lake Louise, Canada, June 1984.     

An investigation of appraisals in individuals vulnerable to excessive worry: the role of intolerance of uncertainty

Several studies have been conducted to examine whether the construct of intolerance of uncertainty (IU) (Dugas, Gagnon, Ladouceur, & Freeston, Behaviour Research and Therapy, 36, 215–226, 1998b) meets formal criteria as a cognitive vulnerability for excessive and uncontrollable worry. Cognitive models of anxiety suggest that vulnerability is manifest in the manner in which individuals process information. As such, cognitive bias is expected to be observed in individuals characterized by high levels of a putative cognitive vulnerability. In this study, individuals low (n = 110) and high (n = 89) on IU were compared on their appraisals of ambiguous, negative, and positive situations. Individuals high on IU appraised all situation types as more disconcerting relative to the comparison group. However, when controlling for demographics, generalized anxiety disorder (GAD) symptoms, and mood variables, the groups differed only in their appraisals of ambiguous situations. Further, in the high-vulnerability group, degree of IU was a stronger predictor of appraisals of ambiguous situations than were GAD symptoms and mood variables. Tests of mediation showed that appraisals of ambiguous situations partly mediated the relationship of IU to worry, the main symptom of GAD; however, worry also emerged as a partial mediator of the relation of IU to appraisals of ambiguous situations. An exploratory analysis revealed that in individuals high on IU, appraisals were not specific to the content of current worries, whereas they were to some extent in individuals low on IU. The results are discussed within the context of findings emerging from cognitive models of GAD, in particular the model proposed by Dugas et al. (1998b).     

Rumination and Vegetative Symptoms: A Test of the Dual Vulnerability Model of Seasonal Depression

The Dual Vulnerability Model of seasonal affective disorder proposes that the cognitive-affective symptoms of seasonal depression are the result of an interaction of a diathesis of cognitive vulnerability to depression and the stressor of seasonal vegetative change. Two studies examined this hypothesis employing a within-subject design with daily data on vegetative and cognitive-affective depressive symptoms. Study 1 included a subclinical sample and a trait measure of ruminative response style. Study 2 included a clinical sample and reports of actual ruminative thoughts and behaviors in response to fatigue. Results of mixed linear model analyses in both studies supported the hypothesis that rumination moderates the relationship between the vegetative symptoms and the cognitive-affective symptoms of seasonal depression. The extension of the model to other subtypes of depression is considered.

Seasonal affective disorder, part I: A review of the neural mechanisms for psychosocial nurses

This article is the first of a two-part series on Seasonal Affective Disorder (SAD). Mental health and nursing researchers are beginning to investigate the implications of seasons on mood and mood states. Delineation of SAD and its treatment by phototherapy is an example. This article reviews the pertinent research regarding the hypothesized neural mechanisms of SAD. Three competing hypothesis are contrasted and compared: the melatonin hypothesis, the phase delay hypothesis, and the photon counting hypothesis. Although no one theory is universally accepted, current data supports the phase delay hypothesis and suggests that morning phototherapy is the most effective treatment.     

Cognitive theories of vulnerability to depression: Reconciling negative evidence

Cognitive theories of depression propose that stable beliefs predispose vulnerable individuals to depression. Empirical evidence appears to contradict the stability hypothesis; the cognitions described by the theories appear to covary with depressive symptoms. As a result of these findings, many investigators have concluded that the etiological portions of the cognitive theories are incorrect. We propose an alternative account of the empirical evidence that is consistent with the theories. We propose that the beliefs that are vulnerability factors for depression are stable, but they are accessible only during negative mood states; we call this the mood-state hypothesis. This article describes the mood-state hypothesis, reviews evidence supporting it, and outlines its implications for the cognitive theories of depression. We also describe implications of the mood-state hypothesis for other theories of depression, including biological theories, for studies of psychotherapy process, for studies of other psychopathologies, for epidemiological studies of depression, for the prevention and treatment of depression, and for theories of cognition.We thank Aaron T. Beck for helpful comments on an earlier version of this article and John Rosenberg for his assistance with the biological section. Portions of this paper were presented at the meetings of the Society for Psychotherapy Research, June 26–30, 1990, Wintergreen, Virginia.     

Cognitive Change Across Cognitive-Behavioral and Light Therapy Treatments for Seasonal Affective Disorder: What Accounts for Clinical Status the Next Winter?

Efficacious treatments for seasonal affective disorder include light therapy and a seasonal affective disorder-tailored form of cognitive-behavioral therapy. Using data from a parent clinical trial, these secondary analyses examined the relationship between cognitive change over treatment with cognitive-behavioral therapy, light therapy, or combination treatment and mood outcomes the next winter. Sixty-nine participants were randomly assigned to 6-weeks of cognitive-behavioral therapy, light therapy, or combination treatment. Cognitive constructs (i.e., dysfunctional attitudes, negative automatic thoughts, and rumination) were assessed at pre- and post-treatment. Dysfunctional attitudes, negative automatic thoughts, and rumination improved over acute treatment, regardless of modality; however, in participants randomized to solo cognitive-behavioral therapy, a greater degree of improvement in dysfunctional attitudes and automatic thoughts was uniquely associated with less severe depressive symptoms the next winter. Change in maladaptive thoughts during acute treatment appears mechanistic of solo cognitive-behavioral therapy’s enduring effects the next winter, but is simply a consequence of diminished depression in light therapy and combination treatment.     

Negative Cognitive Styles and Stress-Reactive Rumination Interact to Predict Depression: A Prospective Study

Research on cognitive theories of depression has identified negative cognitive styles and rumination in response to depressed mood as risk factors for depressive episodes. In addition, a general self-focusing style has been suggested to increase vulnerability to depression. The present study used a behavioral high-risk paradigm to test whether the interaction of negative cognitive styles and rumination predicted the prospective onset, number, and duration of depressive episodes in a sample of 148 initially nondepressed undergraduates over a 2.5-year follow-up. In addition, rumination was assessed specifically as the tendency to focus on maladaptive self-referential thoughts following stressful events (stress-reactive rumination; SRR). The principal hypotheses tested were (1) the interaction of negative cognitive styles and SRR increases risk for developing depressive episodes as well as longer duration depressive episodes; and (2) this interaction would not be obtained when a trait measure of general self-focus or a measure of rumination in response to depressed mood is used instead of the measure of SRR. After controlling for subsyndromal depressive symptoms and the main effects of negative cognitive styles and SRR, the interaction of negative cognitive styles and SRR was found to predict the prospective onset, number, and duration of major depressive and hopelessness depressive episodes. These interactions were not obtained when other measures of trait self-focus and depressive rumination were used instead of SRR.     

基于不愉快症状理论乳腺癌患者化疗相关认知障碍的研究进展

本文介绍了乳腺癌患者化疗相关认知障碍的概念、不愉快症状理论模型、化疗相关认知障碍的影响因素及现状,影响因素基于不愉快症状理论从症状产生的生理、心理和情境层面进行总结,以期为医务人员早期识别乳腺癌患者化疗相关认知障碍,针对性提高其认知功能提供理论依据。     

Violence, stress, and somatic syndromes

Syndromes characterized by pain, fatigue, mood disorder, cognitive dysfunction, and sleep disturbance have been referred to as stress-related somatic disorders by virtue of the observation that onset and exacerbation of symptoms occur with stress. These syndromes include but are not limited to fibromyalgia, chronic fatigue syndrome, temporomandibular disorder, and irritable bowel syndrome. As with most chronic illnesses, genetic susceptibility and lifetime environmental exposures play a role in creating vulnerability to disease. Cumulative lifetime stress has been associated with a number of physiologic changes in the brain and body that reflect dysregulated hormonal and autonomic activity. Exposure to the stressor of violence is likely to create a state of vulnerability for the stress-related somatic syndromes and also to contribute to symptom expression and severity. Understanding the relationship between violence, stress, and somatic syndromes will help in clarifying the consequences of violence exposure to long-term health and health-related quality of life.     

The schema questionnaire: Investigation of psychometric properties and the hierarchical structure of a measure of maladaptive schemas

Although schemas play a central role in cognitive conceptualizations of personality disorders, research devoted to the assessment of schemas has been scarce. This article describes the preliminary validation of a measure of schemas relevant to personality disorders. The Schema Questionnaire (SQ) was developed using five independent samples (N=1,564). In study 1, factor analyses using a student sample revealed 13 primary schemas. A hierarchical factor analysis revealed three higher-order factors. In study 2, factor analyses using a patient sample revealed 15 primary schemas. The patient and student samples produced similar sets of primary factors which also closely matched the rationally developed schemas and their hypothesized hierarchical relationships (Young, 1991). The primary subscales were found to possess adequate test-retest reliability and internal consistency. In study 3, the SQ was found to possess convergent and discriminant validity with respect to measures of psychological distress, self-esteem, cognitive vulnerability for depression, and personality disorder symptoms.The authors would like to thank Dr. Jane Rigg for her assistance in data collection.     

Heart Rate Variability Predicts Cognitive Reactivity to a Sad Mood Provocation

Cognitive reactivity??the tendency to think negatively in response to a sad mood??is an important predictor of depression vulnerability. The current study examined whether heart rate variability, a physiological index of emotion regulation capacity, predicts individual differences in cognitive reactivity. Heart rate variability in the high frequency spectrum was assessed during a 5-min rest period among a sample of healthy, female adults (N = 67). Participants then completed an assessment of dysfunctional attitudes before and after watching a movie designed to elicit a sad mood. Lower heart rate variability was associated with greater change in dysfunctional attitudes. This relationship persisted after controlling for (a) current depressive symptoms and history of depressive disorder, and (b) other physiological indices, including resting skin conductance, respiration, and heart rate. Findings suggest that low physiological capacity to regulate emotions may contribute to depression vulnerability via increased cognitive reactivity.     

Coping with rheumatoid arthritis pain in daily life: within-person analyses reveal hidden vulnerability for the formerly depressed

This study examined the association between history of depression and day-to-day coping with rheumatoid arthritis (RA) pain. The sample was 188 RA-diagnosed participants, 73 of whom were identified by a structured clinical interview as having a history of major depression. None had current major depression. All participated in a 30-day prospective study in which they made end-of-day ratings of their arthritis pain, the strategies for how they coped with their pain, their appraisals of daily pain, and daily mood. Hierarchical linear models evaluated whether individuals with and without depression history differed in their average pain and the other daily measures; and separately, whether they differed in their within-person associations between pain and the daily measures (e.g., the day-to-day contingency between pain and mood). All analyses controlled for current mild depressive symptoms, neuroticism, and age. Previously depressed individuals were indistinguishable from their never depressed peers in their average pain and the other daily measures; however, the previously depressed exhibited significantly stronger associations between pain and several aspects of their daily emotional experience, suggesting more pain-contingent well-being. For individuals with a history of depression, increases in daily pain corresponded with more frequent efforts to cope with their pain by venting their emotions, significantly stronger impairments in mood, and, if they were also presently distressed, reduced perceptions of control over their pain, compared to the never depressed. Patterns suggest that formerly depressed individuals exhibit a hidden vulnerability in how they manage chronic pain. This vulnerability is best revealed by a daily process approach.     

Spinal cord injury‐related pain in rehabilitation: A cross‐sectional study of relationships with cognitions,mood and physical function

Although psychological aspects of SCI‐related pain have been investigated in those with chronic pain, little data is available regarding these factors in those early in the course of the injury. Using a sample admitted for SCI rehabilitation, this paper describes the relationships between usual pain intensity, mood, disability and both pain and SCI‐related psychological factors. The sample were largely similar to other samples of individuals with SCI‐related chronic pain in terms of mood, but were noted to be less catastrophic in their thinking about pain than a comparative pain clinic sample. They also reported SCI self‐efficacy and acceptance scores consistent with other SCI samples. Compared with other SCI populations there were mixed findings in relation to physical disability. Consistent with previous findings in chronic pain SCI samples, usual pain intensity was found to have a strong relationship with symptoms of anxiety and depression, and pain‐related life interference. SCI acceptance was significantly negatively associated with depression scores, pain catastrophizing was significantly positively associated with both anxiety and depression scores, and SCI self‐efficacy was significantly negatively associated with both anxiety and depression scores. SCI self‐efficacy was also significantly positively associated with physical function scores. These findings suggest that pain‐related psychological factors may have importance even early in the clinical course following SCI, but that it is important, however, to consider more general SCI‐related psychological factors alongside them. In addition, these findings suggest the possibility that early interventions based upon the cognitive behavioural treatment of pain may be integrated into SCI rehabilitation programmes.